Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.418
Filtrar
1.
J Korean Med Sci ; 36(3): e31, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33463097

RESUMO

The coronavirus disease 2019 pandemic has caused a breakdown in the healthcare system worldwide. The need to rapidly update guidelines in order to control the transmission in the population and for evidenced-based healthcare care has led to the need for timely, voluminous and valid research. Amid the quest for a vaccine and better therapies, researchers clamouring for information has led to a wide variety of ethical issues due to the unique situation. This paper aims to examine the positive and negative aspects of recent changes in the process of obtaining informed consent. The article outlines the various aspects, from history, previously described exemptions to consenting as well as those implemented during the pandemic and the current impact of virtual methods. Further, the authors make recommendations based on the outcome of suggested adjustments described in the literature. This article looks into increasing the awareness of physicians and researchers about ethical issues that need to be addressed to provide optimal care for patients while assuring their integrity and confidentiality.


Assuntos
Consentimento Livre e Esclarecido/ética , Editoração/ética , /prevenção & controle , /transmissão , Medicina Baseada em Evidências , Disparidades em Assistência à Saúde/ética , Humanos , Pandemias , Educação de Pacientes como Assunto/ética , Relações Médico-Paciente/ética
3.
Rev. cuba. salud pública ; 46(3): e1575, jul.-set. 2020. tab, graf
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1144555

RESUMO

Introducción: Las condiciones crónicas de salud demandan un cuidado continuo con enfoque en el método clínico centrado en la persona, que incluye la relación médico-paciente como un elemento transversal, siendo la confianza el eje principal. Esta confianza podría mediar entre el manejo de las condiciones crónicas de los pacientes y sus efectos. Objetivo: Identificar el efecto de la confianza en la relación paciente-proveedor de salud en los diversos contextos de salud. Métodos: Se efectuó una revisión crítica de la literatura durante los meses de junio a agosto del 2017, para comprender el rol de la confianza en la relación entre el paciente-proveedor de salud y su relación con los resultados en salud. La búsqueda inicial fue con las palabras clave: confianza, médico, proveedor de salud, paciente y sus variantes en inglés y francés, en las bases de datos electrónicas JSTOR (Filosofía), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete y ProQuest Central. Se aplicaron diferentes estrategias de búsqueda con las palabras claves y el operador boleano AND. Conclusiones: La confianza es una variable de la relación paciente-proveedor de salud que tiene un rol estratégico en los procesos terapéuticos. De ahí que sea fundamental considerarla como parte de la atención en salud, en especial como una instancia de colaboración y compromiso del paciente con su salud. Por lo que se hace necesario crear instrumentos que midan esta variable de acuerdo a las características culturales de los países latinoamericanos y que se extienda a todos los que tienen un rol asistencial en el contacto directo con el paciente(AU)


ABSTRACT Introduction: Health's chronic conditions demand continuous care with an approach to the clinical method focused in the person, which includes physician-patient relation as a cross-sectional element where confidence is the core. This confidence would mediate between the management of the patient's chronic conditions and their effects. Objective: To identify the effect of confidence in health provider/professional-patient relation in different health contexts. Methods: It was carried out a critical review of related literature from June to August, 2017 in order to understand the role of confidence in health provider- patient relation, and its relation with the results in health. The initial search was with the keywords: ´confidence, physician, health provider, patient and their equivalents in English and French, in the electronic databases JSTOR (Philosophy), Race Relations Abstracts, SocIndex with Full Text, Social Science Database, PubMed Central, CINAHHL, Nursing & Allied Health Database, Web of Science, Academic Search Complete and ProQuest Central. There were carried out different search strategies with the keywords and the boolean operator AND. Conclusions: Confidence is a variable of the atient-health provider relation that has a strategic role in therapeutic processes. Then, it is important to consider it as a part of health care, specially as a point of collaboration and commitment of the patient with his/her health. Thus, it is necessary to create instruments that measure this variable in accordance with the cultural characteristics of Latin American countries and this can be extended to all having a care role in the direct contact with patients(AU)


Assuntos
Humanos , Masculino , Feminino , Relações Médico-Paciente/ética , Doença Crônica/psicologia , Confiança/psicologia
4.
S Afr Med J ; 110(6): 461-462, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32880552

RESUMO

Given the increasing numbers of ethical and legal issues arising from the COVID-19 epidemic, particularly in respect of patient-doctor confidentiality, doctors must explain to patients how the measures taken to combat the spread of the virus impact on their confidentiality. Patients must be reassured that doctors are ethically bound to continue to respect such confidentiality, but it should be made clear to them that doctors must also comply with the demands of the law. While the Constitution, statutory law and the common law all recognise a person's right to privacy, during extraordinary times such as the COVID-19 pandemic, confidentiality must be breached to a degree to halt the spread of the virus.


Assuntos
Confidencialidade/legislação & jurisprudência , Infecções por Coronavirus/epidemiologia , Ética Médica , Relações Médico-Paciente/ética , Pneumonia Viral/epidemiologia , Confidencialidade/ética , Infecções por Coronavirus/prevenção & controle , Humanos , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle
5.
Proc Natl Acad Sci U S A ; 117(35): 21194-21200, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32817561

RESUMO

Recent work has emphasized the benefits of patient-physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn-physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.


Assuntos
Grupos Étnicos/psicologia , Mortalidade Infantil/tendências , Relações Médico-Paciente/ética , Comunicação , Grupos de Populações Continentais/etnologia , Grupos de Populações Continentais/psicologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Médicos , Estados Unidos
6.
Rev. bioét. derecho ; (49): 7-23, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192091

RESUMO

El objetivo de este artículo es definir y clarificar el criterio del mejor interés (CMI) como un principio ético para la toma de decisiones por representación. En primer lugar, se exponen algunas propuestas conceptuales como la de Kopelman y Buchanan y Brock. En segundo lugar, analizamos algunas críticas que se han hecho al CMI. Por último, este trabajo responde algunas críticas y hace una propuesta integradora


The aim of this paper defines and clarifies the best interest criterion (BIC) as an ethical principle to substitute decision-making. First, this work exposes some conceptual proposals such as Kopelman and Buchanan and Brock. Second, the authors analyze some criticisms that have been made to BIC. Third, we want to respond such critics and we do a conciliatory proposal


L'objectiu d'aquest article és definir I clarificar el criteri del millor interès (CMI) com un principi ètic per a la presa de decisions per representació. En primer lloc, s'exposen algunes propostes conceptuals com la de Kopelman I Buchanan I Brock. En segon lloc, analitzem algunes crítiques que s'han fet al CMI. Finalment, aquest treball dóna resposta a algunes crítiques I fa una proposta integradora


Assuntos
Humanos , Criança , Tomada de Decisões/ética , Pediatria/ética , Bioética , Relações Médico-Paciente/ética , Competência Mental/legislação & jurisprudência , Suspensão de Tratamento/legislação & jurisprudência , Moral
7.
Rev. bioét. derecho ; (49): 25-40, jul. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192092

RESUMO

La relación médico-paciente se encuentra en un proceso de cambio y evolución hacia un tratamiento más humano, sustentado sobre el principio de autonomía, con el objetivo de respetar los derechos del paciente y no sólo imponer la voluntad del médico. Un instrumento que salvaguarda esta situación es el Documento de Voluntades Anticipadas, como extensión del consentimiento informado. A pesar de su regulación internacional y nacional, en ciertos contextos, como el de la salud mental, el modelo hegemónico-paternalista sigue imperando y nos preguntamos por qué


The doctor-patient relations are undergoing a process of change and evolution towards a more humane approach, based on the principle of autonomy , with the aim of respecting the rights of patients and not just imposing the will of the phyisician. Advance Directives, as an extension of Informed Consent documents, can further safeguard such rights. Despite its international and national regulation, in certain contexts, such as mental health, the hegemonic-paternalistic model persists, and the authors question the underlying motive


La relació metge-pacient es troba en un procés de canvi I evolució cap a un tractament més humà basat en el principi d'autonomia, amb l'objectiu de respectar els drets del pacient I no només imposar la voluntat de metge. Un instrument que salvaguarda aquesta situació és el Document de Voluntats Anticipades, com a extensió del consentiment informat. Malgrat la seva regulació internacional I nacional, en certs contextos, com el de la salut mental, el model hegemònic-paternalista segueix imperant I ens preguntem per què


Assuntos
Humanos , Diretivas Antecipadas/ética , Diretivas Antecipadas/legislação & jurisprudência , Legislação Médica , Saúde Mental/ética , Pessoas Mentalmente Doentes/legislação & jurisprudência , Planejamento/ética , Saúde Mental/legislação & jurisprudência , Planejamento/legislação & jurisprudência , Relações Médico-Paciente/ética , Autonomia Pessoal , Assistência Centrada no Paciente/ética
8.
BMJ ; 370: m1668, 2020 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690477

RESUMO

Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights "predictive coding" and "bayesian brain" as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.


Assuntos
Dor Crônica/tratamento farmacológico , Relações Médico-Paciente/ética , Placebos/efeitos adversos , Padrões de Prática Médica/ética , Teorema de Bayes , Dor Crônica/psicologia , Decepção , Método Duplo-Cego , Ética Médica , Humanos , Efeito Placebo , Placebos/administração & dosagem , Padrões de Prática Médica/estatística & dados numéricos
9.
PLoS One ; 15(7): e0236145, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687536

RESUMO

PURPOSE: Relationship boundaries recognition is an essential element of medical practice. The aim of the study was to assess final year medical students' perceived need for education regarding professional boundaries. MATERIALS AND METHODS: This was a cross-sectional study. An anonymous paper questionnaire was distributed to 128 final year medical students. Standard descriptive statistics, unpaired t-test to evaluate differences between male and female groups and Pearson correlation to determine relationships between variables were used. RESULTS: The survey was completed by 84.4% of students who identified the need for more emphasis in the curriculum for all of topics during training and practice pertaining to boundaries and relationships (mean 6.61±1.32 on a scale of 0 to 9; and 6.66±1.27 respectively). Topics with a high interest ranking requiring additional attention were mistreatment of medical students (mean 7.22±1.96), coping with mistakes in clinical care (mean 7.25±1.63), reporting of medical mistakes (mean 7.58±1.36), and gender bias in clinical care (mean 7.10±1.82). Women perceived a greater need for attention to all topics in the curriculum. Significant differences between the perceptions of female and male students were observed regarding topics such as responding to an impaired colleague (p<0.001), and a physician's social responsibilities (p = 0.001). CONCLUSION: Medical students recognized the need for more education and training in the undergraduate medical ethics curriculum regarding patient-physician relationship boundaries.


Assuntos
Estágio Clínico , Aprendizagem , Relações Médico-Paciente/ética , Adulto , Estudos Transversais , Ética Médica , Feminino , Humanos , Masculino , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
11.
Rev. salud pública ; 22(3): e184536, May-June 2020.
Artigo em Inglês | LILACS | ID: biblio-1115880

RESUMO

ABSTRACT This article attempts to reflect on the importance of thinking in general about illness and about cancer, from an ethical perspective. This approach reveals the central role of personal dignity and the moral relevance that supports the reasons for respecting people. The ethical values that sustain the practice of medicine must aim at uplifting this dignity and seeking situations of justice, since living in a community expresses intersubjectivity that cannot be truncated by illnesses like cancer. Therefore, situations involving poverty cannot justify the lack of health care, and if such lacks occur, they run counter to ethical awareness in the deepest sense and destroy intersubjectivity. As a result, cancer is suffered as a vital experience, in a framework of lives that are lived and are not simply objects of study; those stricken with cancer are individuals who are denied the human right to health, and undergo the elimination of their dignity, the cancelation of justice, and a death sentence. Society is part of these actions and at the same time, suffers from the disappearance of hope. In this sense, the process of informed consent is used as a tool that encourages dialog and understanding between doctors and patients during proper treatment, on a shared path.(AU)


RESUMEN El artículo pretende hacer una reflexión sobre la importancia de pensar, en general, la enfermedad y, en particular, el cáncer, desde una perspectiva ética. Este acercamiento permite vislumbrar el papel central que tiene la dignidad de las personas y la relevancia moral que apuntalan las razones por las cuales ellas han de ser respetadas. Los valores éticos que sustentan la práctica médica han de apelar a enaltecer dicha dignidad y buscar situaciones de justicia, dado que vivir en comunidad da cuenta de una intersubjetividad que no puede ser truncada por enfermedades como el cáncer. Esto evidencia que las situaciones de pobreza no pueden justificar la carencia de cuidados de salud y que, cuando esto sucede, se contraviene, desde lo más hondo, una conciencia de carácter ético y se rompe la intersubjetividad. El cáncer se sufre en tanto experiencia vital, en un marco de vidas vividas y no simplemente de objetos de estudio; los enfermos son personas a quienes se les niega el derecho humano de la salud, se les borra su dignidad, se cancela la justicia y se les condena a la muerte. La sociedad es parte de estas acciones y a la vez sufre la cancelación de esperanzas. En este sentido, se retoma el proceso del consentimiento informado (CI) como una herramienta que permite el diálogo y la comprensión entre médicos y pacientes en la atención digna, en un camino compartido.(AU)


Assuntos
Justiça Social/ética , Pessoalidade , Consentimento Livre e Esclarecido/ética , Neoplasias/psicologia , Relações Médico-Paciente/ética , Pobreza
12.
J Surg Res ; 253: 193-200, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32380345

RESUMO

BACKGROUND: Use of digital devices have become ubiquitous in healthcare and can create professionalism issues. This study presents opinions of faculty, residents, and medical students to inform policy on the appropriate use of digital devices in the patient care setting. MATERIALS AND METHODS: A survey was administered from September 2018 to October 2018 to faculty and residents within the general surgery department at a large academic medical center and all fourth-year medical students at an affiliated university. The survey included direct statements and case-based scenarios on similar themes to triangulate responses. RESULTS: There were 114 participants in the survey-50 faculty, 26 residents, and 38 medical students. Digital device utilization was equivalent among all groups, and all participants use a smartphone. Digital devices were most frequently used during rounds and clinical conferences. Overall, digital device use was found more appropriate when seen in the case-based format rather than as a direct statement. Furthermore, use of these devices was seen as most appropriate when the provider explained its use or left the room to use the device. CONCLUSIONS: Digital devices are used by faculty and trainees at similar rates for parallel purposes, and the benefits for patient-related care are evident. However, the use of digital devices in the presence of patients should be minimized and always preceded by an explanation. These findings can inform institutional policy when creating guidelines on the professional use of these devices in the patient care setting.


Assuntos
Ética Médica , Comportamento de Busca de Informação/ética , Profissionalismo/ética , Smartphone/ética , Adulto , Docentes de Medicina/ética , Docentes de Medicina/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/ética , Internato e Residência/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente/ética , Projetos Piloto , Smartphone/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Visitas com Preceptor/ética
13.
J Med Internet Res ; 22(5): e15685, 2020 05 05.
Artigo em Inglês | MEDLINE | ID: mdl-32369028

RESUMO

BACKGROUND: Gift giving from patients to physicians, which is prohibited in traditional clinical settings in China, has been found to occur in online health communities. However, there is debate on the validity of online gifts since physicians gain an economic benefit. Moreover, the potential impact of these gifts, particularly with respect to the financial value of the gift, on the online consultation service quality remains unexplored. OBJECTIVE: The aim of this study was to explore the impact of gift price on the quality of physicians' online consultation service. Insight into this impact is expected to help resolve existing debate on the appropriateness of the gift-giving practice in online consultations. METHODS: A dataset of 141 physicians and 4249 physician-patient interactions was collected from the Good Physician Online website, which is the largest online consultation platform in China. Based on social exchange theory, we investigated how gift price affects the quality of physicians' online consultation service and how this impact changes according to the physician's service price and number of all gifts received. Manual annotation was used to identify the information support paragraphs and emotional support paragraphs in the answers of physicians. The quality of the information support paragraphs, rather than the complete answer, was used to test the robustness of our model. RESULTS: Gift price had a positive impact on the quality of physicians' online consultation service (ß=4.941, P<.01). This impact was negatively mediated by both the physician's service price (ß=-9.245, P<.001) and the total number of gifts they received (ß=-5.080, P<.001). CONCLUSIONS: Gift price has a positive impact on physicians' online behavior, although the impact varies among physicians.


Assuntos
Doações , Relações Médico-Paciente/ética , Telemedicina/métodos , Adulto , Pesquisa Empírica , Feminino , Humanos , Masculino
14.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32398328

RESUMO

A 15-year-old girl is scheduled to undergo an upper lobectomy to debulk metastatic Ewing sarcoma. The anesthesiologist recommended placement of a thoracic epidural catheter to provide postoperative analgesia. The patient did not want a needle to be placed near her spine. She was terrified that the procedure would be painful and that it might paralyze her. Although the anesthesiologist reassured her that sedation and local anesthesia would make the procedure comfortable, she remained vehemently opposed to the epidural procedure. The parents spoke privately to the anesthesiologist and asked for placement of the epidural after she was asleep. They firmly believed that this would provide optimal postoperative analgesia and thus would be in her best interest. Experts discuss the pros and cons of siding with the patient or parents.


Assuntos
Comportamento do Adolescente/ética , Anestesia Epidural/ética , Dor Pós-Operatória/prevenção & controle , Relações Pais-Filho , Relações Médico-Paciente/ética , Recusa do Paciente ao Tratamento/ética , Adolescente , Comportamento do Adolescente/psicologia , Anestesia Epidural/métodos , Anestesia Epidural/psicologia , Neoplasias Ósseas/psicologia , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Dor Pós-Operatória/psicologia , Pais/psicologia , Sarcoma de Ewing/psicologia , Sarcoma de Ewing/cirurgia , Recusa do Paciente ao Tratamento/psicologia
15.
Proc Natl Acad Sci U S A ; 117(21): 11368-11378, 2020 05 26.
Artigo em Inglês | MEDLINE | ID: mdl-32381738

RESUMO

Over the past several decades, the United States medical system has increasingly prioritized patient autonomy. Physicians routinely encourage patients to come to their own decisions about their medical care rather than providing patients with clearer yet more paternalistic advice. Although political theorists, bioethicists, and philosophers generally see this as a positive trend, the present research examines the important question of how patients and advisees in general react to full decisional autonomy when making difficult decisions under uncertainty. Across six experiments (N = 3,867), we find that advisers who give advisees decisional autonomy rather than offering paternalistic advice are judged to be less competent and less helpful. As a result, advisees are less likely to return to and recommend these advisers and pay them lower wages. Importantly, we also demonstrate that advisers do not anticipate these effects. We document these results both inside and outside the medical domain, suggesting that the preference for paternalism is not unique to medicine but rather is a feature of situations in which there are adviser-advisee asymmetries in expertise. We find that the preference for paternalism holds when advice is solicited or unsolicited, when both paternalism and autonomy are accompanied by expert guidance, and it persists both before and after the outcomes of paternalistic advice are realized. Lastly, we see that the preference for paternalism only occurs when decision makers perceive their decision to be difficult. These results challenge the benefits of recently adopted practices in medical decision making that prioritize full decisional autonomy.


Assuntos
Tomada de Decisões , Autonomia Pessoal , Relações Médico-Paciente , Adulto , Chicago , Feminino , Administração Financeira/ética , Humanos , Internet , Masculino , Medicina , Paternalismo , Relações Médico-Paciente/ética , Local de Trabalho
19.
Otolaryngol Head Neck Surg ; 163(1): 63-64, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32340553

RESUMO

The COVID-19 pandemic has forced otolaryngologists and their patients to confront issues that they have rarely if ever previously faced. Prominent among these is the need to put the collective good ahead of the interests of individual patients with otolaryngologic disorders. We argue that the individual doctor-patient relationship remains paramount even at a time when public health principles mandate systems-level thinking.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Otorrinolaringologistas/psicologia , Pandemias , Relações Médico-Paciente/ética , Pneumonia Viral/epidemiologia , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA